Provider Demographics
NPI:1164139630
Name:KUTCHMARK, LORI A (PTA)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:KUTCHMARK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8166 COUNTY ROAD 56
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:OH
Mailing Address - Zip Code:43944-7825
Mailing Address - Country:US
Mailing Address - Phone:740-827-1044
Mailing Address - Fax:
Practice Address - Street 1:250 CADIZ RD
Practice Address - Street 2:
Practice Address - City:WINTERSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43953-3928
Practice Address - Country:US
Practice Address - Phone:740-827-1044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02761225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant